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Eur Radiol. 2016 Mar;26(3):849-57. doi: 10.1007/s00330-015-3895-9. Epub 2015 Jul 3.

3D quantitative assessment of response to fractionated stereotactic radiotherapy and single-session stereotactic radiosurgery of vestibular schwannoma.

Author information

1
Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Neuroradiology, The Johns Hopkins Hospital School of Medicine, Baltimore, MD, 21287, USA. tan.schneider@uke.de.
2
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany. tan.schneider@uke.de.
3
Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Interventional Radiology, The Johns Hopkins Hospital School of Medicine, Baltimore, MD, 21287, USA.
4
Ultrasound Imaging and Interventions (UII), Philips Research North America, Briarcliff Manor, NY, USA.
5
Department of Radiology and Imaging Science, Yale University School of Medicine, New Haven, CT, USA.
6
Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
7
Department of Neurological Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
8
Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Neuroradiology, The Johns Hopkins Hospital School of Medicine, Baltimore, MD, 21287, USA.

Abstract

OBJECTIVES:

To determine clinical outcome of patients with vestibular schwannoma (VS) after treatment with fractionated stereotactic radiotherapy (FSRT) and single-session stereotactic radiosurgery (SRS) by using 3D quantitative response assessment on MRI.

MATERIALS:

This retrospective analysis included 162 patients who underwent radiation therapy for sporadic VS. Measurements on T1-weighted contrast-enhanced MRI (in 2-year post-therapy intervals: 0-2, 2-4, 4-6, 6-8, 8-10, 10-12 years) were taken for total tumour volume (TTV) and enhancing tumour volume (ETV) based on a semi-automated technique. Patients were considered non-responders (NRs) if they required subsequent microsurgical resection or developed radiological progression and tumour-related symptoms.

RESULTS:

Median follow-up was 4.1 years (range: 0.4-12.0). TTV and ETV decreased for both the FSRT and SRS groups. However, only the FSRT group achieved significant tumour shrinkage (p < 0.015 for TTV, p < 0.005 for ETV over time). The 11 NRs showed proportionally greater TTV (median TTV pre-treatment: 0.61 cm(3), 8-10 years after: 1.77 cm(3)) and ETV despite radiation therapy compared to responders (median TTV pre-treatment: 1.06 cm(3); 10-12 years after: 0.81 cm(3); p = 0.001).

CONCLUSION:

3D quantification of VS showed a significant decrease in TTV and ETV on FSRT-treated patients only. NR had significantly greater TTV and ETV over time.

KEY POINTS:

Only FSRT not GK-treated patients showed significant tumour shrinkage over time. Clinical non-responders showed significantly less tumour shrinkage when compared to responders. 3D volumetric assessment of vestibular schwannoma shows advantages over unidimensional techniques.

KEYWORDS:

Benign neoplasms; Gamma Knife radiosurgery; Magnetic resonance imaging; Radiotherapy; Vestibular schwannoma

PMID:
26139318
PMCID:
PMC4698362
DOI:
10.1007/s00330-015-3895-9
[Indexed for MEDLINE]
Free PMC Article
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